Assessment of the quality of pediatric cardiopulmonary resuscitation using the in situ mock code tool / Avaliação da qualidade da ressuscitação cardiopulmonar pediátrica por meio da ferramenta in situ mock code

ABSTRACT Objective: To evaluate the quality of individual and team care for cardiac arrest in a pediatric hospital using clinical surprise simulation (in situ mock code). Methods: We conducted an observational study with a sample of the hospital staff. Clinical simulations of cardiorespiratory arrest were performed in several sectors and work shifts. The mock code occurred in vacant beds of the sector without previous notification to the teams on call. One researcher conducted all mock codes and another evaluated individual and team attendance through a questionnaire contemplating recommendation for adequate cardiopulmonary resuscitation, based on the Pediatric Advanced Life Support (PALS) guidelines. At the end of the simulations, the research team provided a debriefing to the team tested. Results: Fifteen in situ mock code were performed with 56 nursing professionals (including nurses, nursing residents and technicians) and 11 physicians (including two pediatric residents and four residents of pediatric subspecialties). The evaluation showed that 46.7% of the professionals identified cardiac arrest checking for responsiveness (26.7%) and pulse (46.7%); 91.6% requested cardiac monitoring and venous access. In one case (8.3%) the cardiac compression technique was correct in depth and frequency, while 50% performed cardiopulmonary resuscitation correctly regarding the proportion of compressions and ventilation. According to PALS guidelines, the teams had a good performance in the work dynamics. Conclusions: There was low adherence to the PALS guidelines during cardiac arrest simulations. The quality of cardiopulmonary resuscitation should be improved in many points. We suggest periodical clinical simulations in pediatric services to improve cardiopulmonary resuscitation performance.

RESUMO Objetivo: Avaliar a qualidade do atendimento individual e de equipe à parada cardiorrespiratória (PCR) em hospital pediátrico, utilizando a ferramenta de simulação clínica surpresa (in situ mock code). Métodos: Estudo observacional transversal com profissionais de saúde. Foram realizadas simulações clínicas de PCR em diversos setores, em turnos variados, em leito vago do setor sem notificação prévia às equipes de plantão. Um pesquisador conduziu todos os mock code e outro avaliou o atendimento individual e de equipe por meio de questionário contendo recomendações para adequada ressuscitação cardiopulmonar baseadas no protocolo do Suporte Avançado de Vida em Pediatria (PALS). Ao término das simulações, realizou-se debriefing com a equipe testada. Resultados: Foram realizados 15 in situ mock code e incluídos 56 profissionais de enfermagem (entre enfermeiros, residentes em enfermagem e técnicos) e 11 médicos (sendo dois residentes em pediatria e quatro pediatras residentes em subespecialidade pediátrica). A avaliação mostrou que profissionais identificaram a PCR checando responsividade (26,7%) e pulso (46,7%); 91,6% solicitaram monitorização cardíaca e acesso venoso. Em um caso (8,3%), a técnica de compressão cardíaca foi correta em profundidade e frequência, enquanto 50% executaram a ressuscitação cardiopulmonar corretamente na proporção de compressão e ventilação. As equipes apresentaram bom desempenho na dinâmica de trabalho, segundo variáveis recomendadas pelo PALS. Conclusões: Houve baixa adesão ao protocolo do PALS durante simulações de PCR, observando-se que a qualidade da ressuscitação cardiopulmonar oferecida pode melhorar em muitos pontos. Sugere-se que, em locais de assistência a pacientes pediátricos, sejam realizados treinamentos com simulações clínicas periódicas para melhor atendimento à PCR pediátrica.

Características perinatais de crianças com transtorno do espectro autista / Perinatal features of children with autism spectrum disorder

RESUMO Objetivo: Analisar características perinatais de crianças com transtorno do espectro autista (TEA). Métodos: Revisão retrospectiva dos prontuários medicos de 75 crianças com TEA, entre janeiro de 2008 e janeiro de 2015. Os critérios de inclusão foram o diagnóstico de TEA baseado no DSM-5 e o termo de consentimento assinado pelo responsável legal. O critério de exclusão foi ausência de todos os dados no prontuário médico. As variáveis analisadas foram: idade materna, prematuridade (idade gestacional menor que 37 semanas), baixo peso ao nascer (<2.500 g) e asfixia perinatal (Apgar menor que 7 no quinto minuto). Os dados foram avaliados por meio do teste de diferença entre as proporções (nível de significância de p<0,05). Resultados: Setenta e cinco pacientes foram incluídos no estudo. A idade materna variou de 21,4 a 38,6 anos (29,8±4,1 anos). O parto prematuro ocorreu em 14 (18,7%) pacientes, asfixia perinatal em 6 (8,0%) e baixo peso ao nascer em 32 (42,6%). As prevalências de prematuridade, asfixia perinatal e baixo peso ao nascer entre as crianças com TEA neste estudo foram maiores do que as prevalências gerais dessas condições entre todos os nascidos vivos em nosso país, região e estado, as quais são, respectivamente, 11,5, 2,3 e 8,5% no Brasil, 11,0; 2,2 e 8,5% na região Sul e 10,5, 2,0 e 8,4% no estado do Paraná. Conclusões: Nossos achados mostraram maior prevalência de prematuridade, baixo peso ao nascer e asfixia perinatal em crianças com TEA. Algumas limitações são o desenho retrospectivo do estudo e a amostra de pequeno tamanho. Grandes estudos prospectivos são necessários para esclarecer a possível associação entre intercorrências perinatais e TEA.

ABSTRACT Objective: To analyze perinatal features of children with autism spectrum disorder (ASD). Methods: Retrospective review of the medical records of 75 children with ASD, between January 2008 and January 2015. Inclusion criteria were diagnosis of ASD based on DSM-5 criteria, and the informed consent form signed by the person who is legally responsible. The exclusion criterion was missing on the medical record. The variables analyzed were maternal age, prematurity (gestational age under 37 weeks), low birth weight (<2,500 g), and perinatal asphyxia (5th minute Apgar score <7). Data were analyzed using the difference between proportions test, being significant p<0.05. Results: Seventy-five patients were included. Maternal age ranged from 21.4 to 38.6 years (29.8±4.1 years). Premature birth occurred in 14 (18.7%) patients, perinatal asphyxia in 6 (8.0%), and low birth weight in 32 (42.6%) patients. The prevalence of prematurity, low birth weight, and perinatal asphyxia among the children in our study was higher than the general prevalence of these conditions among all live births in our country, region, and state, which are, respectively, 11.5, 2.3, and 8.5% in Brazil; 11.0, 2.2, and 8.5% in Southern Brazil; and 10.5, 2.0, and 8.4% in the state of Paraná. Conclusions: Our findings show a higher prevalence of prematurity, low birth weight, and perinatal asphyxia among children with ASD. Some limitations are the retrospective study design, and the small sample size. Large prospective studies are needed to clarify the possible association between perinatal complications and ASD.

Epilepsy and eeg abnormalities in children with autism spectrum disorder / Epilepsia e anormalidades eletroencefalográficas em crianças com transtorno no espectro do autismo / Epilepsia y anormalidades electroencefalográficas en niños con trastorno en el espectro del autismo

Introduction: Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder characterized by impaired communication and social interaction, and by restricted and repetitive behavior. Children with ASD are more likely to have seizu- res than children with normal neurological development. Objective: Analyze the incidence of seizures and EEG abnormalities in a cohort of 63 patients with ASD. Methods: Children with autism were included in the study, which calculated the incidence of epilepsy and analyzed the main abnormalities in the EEG. All the patients were evaluated by the same physician, and underwent EEG and MRI of the brain. Results: A total of 63 patients were included between January 2010 and January 2015; 23 (36.51%) female and 40 (63.49%) male; ages at diagnosis ranged from 17 to 58 months (35.97 ± 11.77 months); in 16 (25.4%) patients the MRI was reported to be abnormal. All the patients with autism and epilepsy had abnormal EEGs; 11 (17.4%) had a diagnosis of epilepsy (n=7; 63.6% female and n=4; 36.4% male); and the mean age at diagnosis of epilepsy was 33.7 ± 4.3 months. Conclusion: Our findings suggest that in patients with autism, epilepsy rates are higher than in the general population, but there is no unique pattern of discharge in the EEG.

Introdução: O transtorno do espectro do autismo (TEA) é um distúrbio de desenvolvimento neural heterogêneo caracterizado por comunicação e interação social deficientes e por comportamento restrito e repetitivo. As crianças com TEA têm maior probabilidade de ter convulsões do que as crianças com desenvolvimento neurológico normal. Objetivo: Analisar a incidência de convulsões e anormalidades eletroencefalográficas em uma coorte de 63 pacientes com TEA. Métodos: Foram incluídas no estudo, crianças com autismo, a incidência de epilepsia foi calculada e as principais anomalias do EEG foram analisadas. Todos os pacientes foram avaliados pelo mesmo médico e foram submetidas a EEG e RM do cérebro. Resultados: De janeiro de 2010 a janeiro de 2015, foram incluídos 63 pacientes, 23 (36,51%) do sexo feminino e 40 (63,49%) do sexo masculino; a idade ao diagnóstico variou de 17 a 58 meses (35,97 ± 11,77 meses); em 16 (25,4%) pacientes o laudo da RM relatou anormalidade. Todos os pacientes com autismo e epilepsia tinham uma anormalidade no EEG, 11 (17,4%) tinham diagnóstico de epilepsia (n = 7; 63,6% meninas e n = 4; 36,4% meninos); a média de idade ao diagnóstico de epilepsia foi 33,7 ± 4,3 meses. Conclusão: Nossos achados sugerem que em pacientes com autismo, as taxas de epilepsia ainda são mais altas do que as da população de risco geral e não existe um padrão único de descarga no EEG.

Introducción: El trastorno del espectro del autismo (TEA) es un disturbio de desarrollo neural heterogéneo caracterizado por comuni- cación e interacción social deficientes y por comportamiento restringido y repetitivo. Los niños con TEA tienen mayor probabilidad de tener convulsiones que los niños con desarrollo neurológico normal. Objetivo: Analizar la incidencia de convulsiones y anormalidades electroencefalográficas en una cohorte de 63 pacientes con TEA. Métodos: Fueron incluidos en el estudio niños con autismo, la incidencia de epilepsia fue calculada y las principales anomalías del EEG fueron analizadas. Todos los pacientes fueron evaluados por el mismo médico y fueron sometidos a EEG y RM del cerebro. Resultados: De enero de 2010 a enero de 2015, fueron incluidos 63 pacientes, 23 (36,51%) del sexo femenino y 40 (63,49%) del sexo masculino; la edad en el momento del diagnóstico varió de 17 a 58 meses (35,97 ± 11,77 meses); en 16 (25,4%) pacientes el laudo de la RM relató anormalidad. Todos los pacientes con autismo y epilepsia tenían una anormalidad en el EEG, 11 (17,4%) tenían diagnóstico de epilepsia (n = 7; 63,6% niñas y n = 4; 36,4% niños); el promedio de edad en el momento del diagnóstico de epilepsia fue 33,7 ± 4,3 meses. Conclusión: Nuestros hallazgos sugieren que en pacientes con autismo, las tasas de epilepsia aún son más altas que las de la población de riesgo general y no existe un estándar único de descarga en el EEG.

Clinical and laboratory characteristics associated with dyslipidemia and liver steatosis in chronic HBV carriers

Introduction Chronic hepatitis B virus (HBV) infection and liver steatosis (LS) are the most common causes of chronic liver disease, and their coexistence is frequently observed in clinical practice. Although metabolic syndrome is the main cause of LS, it has not been associated with HBV infection. The aims of this study were to describe the lipid profile and prevalence of LS among HBV carriers and to identify the characteristics associated with LS in this group. Methods This retrospective cross-sectional study included hepatitis B surface antigen (HBsAg)-positive patients evaluated during 2011 and 2012. Results Of the 83 patients included, the mean age was 46.4±12.5 years, 53% were men, and 9.1% were hepatitis B e antigen (HBeAg) -positive. These patients exhibited the following lipid profile: total cholesterol = 175.4±38.8mg/dL, low-density lipoprotein (LDL) = 113.0±32.7mg/dL, and triglycerides = 91.1±45.2mg/dL. Their fasting glucose was 95.3±14.5g/dL, and fasting insulin was 6.1±5.9µIU/mL. Liver steatosis was observed on abdominal ultrasound in 11.3% of individuals. Factors associated with the presence of LS included higher levels of total cholesterol, prothrombin activity, fasting insulin, and body mass index (BMI) as well as lower levels of aspartate aminotransferase (AST). Conclusions These findings suggest that LS in patients with chronic HBV appears to be a consequence of metabolic alterations and insulin action rather than of viral factors. .

Evaluation of immunohistochemical expression of ghrelin-producing rectal cells in Wistar rats underwent to the cafeteria diet

PURPOSE:To investigate the impact of cafeteria diet on ghrelin expression in rectal tissue and identify the morphologic cell type. METHODS:Twenty-four male Wistar rats were divided into four subgroups of six animals each: RC1 (rat chow 1) and CAF1 (cafeteria diet 1) for a period of 30 days; RC2 (rat chow 2) and CAF2 (cafeteria diet 2) for a period of 60 days. The animal and rectal weight, the number and the type of immunoreactive ghrelin cells were recorded and compared between the subgroups. The statistical study was established by ANOVA and Student's t test. RESULTS:There was no difference in the total of immunoreactive cells (p=0.685) between the subgroups nor between weight and presence or absence of ghrelin expression (p=0.993). All the immunoreactive cells identified were closed-type. CONCLUSION:The cafeteria diet did not have influence on the amount of immunoreactive rectal cells of ghrelin and only one type (closed-type) of immunoreactive cells was expressed in the rectum.

Prevalence and clinical features of celiac disease in patients with hepatitis B virus infection in Southern Brazil

Introduction Celiac disease is an autoimmune disorder that involves gluten intolerance and can be triggered by environmental factors including hepatitis B virus (HBV) infection. This study aimed to describe the prevalence of celiac disease in individuals with HBV infection and to describe the clinical and laboratory characteristics of celiac disease associated with HBV. Methods This cross-sectional study included 50 hepatitis B patients tested for IgA anti-endomysial antibodies (EMAs) and tissue anti-transglutaminase (TTG) between August 2011 and September 2012. Results Fifty patients were included with a mean age of 46.0 ± 12.6 (46.0) years; 46% were female and 13% were HBeAg+. Six patients had positive serology for celiac disease, four were EMA+, and five were TTG+. When individuals with positive serology for celiac disease were compared to those with negative serology, they demonstrated a higher prevalence of abdominal pain (100% vs. 33.3%, p = 0.008), lower median creatinine (0.7mg/dL vs. 0.9mg/dL, p = 0.007) and lower mean albumin (3.6 ± 0.4g/L vs. 3.9 ± 0.3g/L, p = 0.022). All individuals with positive serology for celiac disease underwent upper digestive endoscopy, and three of the patients exhibited a macroscopic pattern suggestive of celiac disease. Histologically, five patients demonstrated an intra-epithelial lymphocytic infiltrate level > 30%, and four patients showed villous atrophy associated with crypt hyperplasia on duodenal biopsy. Conclusions An increased prevalence of celiac disease was observed among hepatitis B patients. These patients were symptomatic and had significant laboratory abnormalities. These results indicate that active screening for celiac disease among HBV-infected adults is warranted. .

Educação sexual de adolescentes na perspectiva freireana através dos círculos de cultura / Sexual education for adolescents in freire’s perspective through culture circles

Objetivou-se descrever e analisar as ações de educação e promoção de saúde sexual para adolescentes de uma escola de ensino fundamental em Florianópolis. Pesquisa de abordagem qualitativa articulada com o referencial de Paulo Freire, consistindo da investigação de temas levantados pelos adolescentes (adolescência, sexualidade, doenças sexualmente transmissíveis e métodos anticoncepcionais), através de círculos de cultura. Dados coletados no segundo semestre de 2011 e participaram 45 alunos da 7ª e 8ª séries. Como resultado, as ações educativas, com foco na promoção de saúde dos adolescentes, estimularam a autonomia do grupo e esclareceram dúvidas sobre a sexualidade e a construção da personalidade, além de questões práticas sobre doenças sexualmente transmissíveis, preconceitos e métodos anticoncepcionais. Os círculos de cultura se mostraram efetivos para ações em educação em saúde sexual, o que condiz com o alto índice de aprovação da atividade pelos alunos.